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Additive values of pelvic tomosynthesis in comparison to pelvic radiography alone for the diagnosis of sacroiliitis in patients with suspected axial spondyloarthritis

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Abstract

Objectives

To compare inter-reader agreement and diagnostic confidence in detecting sacroiliitis by the modified New York criteria (mNY) on digital radiography (DR) versus digital pelvic tomosynthesis assisted DR (DR+DPT), and to evaluate changes in the presence of axial spondyloarthritis (axSpA) according to the Assessment of Spondyloarthritis International Society (ASAS) criteria.

Methods

One hundred and thirty-eight patients who underwent both DR and DPT with suspicious axSpA in our rheumatologic clinic were included from February 2017 to February 2018. Three radiologists independently graded sacroiliitis and confidence level on DR first and then re-graded them on DPT in a paired manner. Agreement, confidence, and diagnostic accuracy were evaluated for readers. Changes in the presence of disease by mNY and ASAS criteria were assessed between DR alone and DR+DPT.

Results

On DR alone, 73 patients were assessed with radiographic sacroiliitis, and 85 were classified into axSpA by the ASAS criteria; however, 78 and 85, respectively, were classified on DR+DPT. With the assistance of DPT, 17 and 12 patients changed to the disease positivity according to the mNY and ASAS criteria, respectively; the negative results changed to positive in 11 and six patients, respectively. For all readers, agreement improved with DPT (0.79 to 0.89). DR+DPT achieved higher diagnostic accuracy (AUC, P < 0.05).

Conclusion

The combination of DR and DPT achieved a higher diagnostic performance than that of DR alone, with better agreement. On DR+DPT, the diagnoses of 9.0% of patients with suspicious axSpA (12 of 134) were changed to the status of disease by the ASAS criteria.

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Author notes

  1. Euddeum Shim and Taeho Ha contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, Republic of Korea

    Euddeum Shim, Taeho Ha & Baek Hyun Kim

  2. Department of Radiology, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea

    Suk-Joo Hong

  3. Department of Radiology, Korea University Anam Hospital, 126-1 Anam-dong 5-ga, Seongbuk-gu, Seoul, 02856, Republic of Korea

    Chang Ho Kang

  4. Mammogrpahy and Radiography Application Specialist, GE Healthcare Korea, 15F, Seoul Square, 416 Hangang-daero, Jung-gu, Seoul, 04637, Republic of Korea

    Sookyung Jeon

  5. Medical Science Research Center, Korea Unversity Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, Republic of Korea

    Jaehyung Cha

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  1. Euddeum Shim
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Correspondence to Baek Hyun Kim.

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This retrospective study was approved by the institutional review board of Korea University Ansan Hospital and informed consent was waived.

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Shim, E., Ha, T., Kim, B.H. et al. Additive values of pelvic tomosynthesis in comparison to pelvic radiography alone for the diagnosis of sacroiliitis in patients with suspected axial spondyloarthritis. Skeletal Radiol 50, 1197–1207 (2021). https://doi.org/10.1007/s00256-020-03626-2

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  • DOI: https://doi.org/10.1007/s00256-020-03626-2

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